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Related Experiment Videos

Third coronary artery bypass operations: risks and costs

B W Lytle1, J L Navia, P C Taylor

  • 1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio 44195, USA.

The Annals of Thoracic Surgery
|December 5, 1997
PubMed
Summary
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Third coronary artery bypass operations carry increased risk, especially for patients 70 or older. However, outcomes for younger patients are favorable, with manageable hospital costs. This highlights age as a key predictor of success.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Reoperations
  • Outcomes Research

Background:

  • Third coronary artery bypass grafting (CABG) is a complex procedure with elevated risks.
  • Identifying factors influencing outcomes is crucial for patient management.

Purpose of the Study:

  • To analyze the outcomes and costs associated with third isolated coronary artery bypass operations.
  • To identify preoperative and operative variables affecting patient results and healthcare expenditures.

Main Methods:

  • Retrospective review of 469 patients undergoing a third isolated CABG.
  • Univariate and multivariate analyses to assess risk factors and cost determinants.

Main Results:

  • In-hospital mortality was 7.0%, significantly higher in patients aged 70+ with severe symptoms (14%).

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  • Long-term survival rates were 94% (1 year), 84% (5 years), and 66% (10 years).
  • Advanced age (≥70), poor left ventricular function, and diabetes predicted decreased late survival. Mean costs were 21% higher than primary CABG, influenced by outliers and female sex.

    • Conclusions:

    • Preoperatively identifiable factors, especially age ≥70, are linked to unfavorable outcomes in third CABG.
    • Patients under 70 experienced low in-hospital mortality and favorable long-term survival.
    • Increased hospital costs are primarily due to a few high-cost cases and are unpredictable.